Institut für Geschlechterforschung in der Medizin, Universitätsmedizin Berlin Charité und Deutsches Herzzentrum Berlin, Germany.
Dtsch Arztebl Int. 2011 Apr;108(16):267-73. doi: 10.3238/arztebl.2011.0267. Epub 2011 Apr 22.
Cardiovascular diseases arise during 0,2% to 4% of all pregnancies in the industrialized world. In Germany, this type of complication, which is sometimes lethal, affects approximately 30 000 pregnant women per year.
We performed a simple literature search in the NCBI databases for publications that appeared from 2008 to 2010 and that contained the search terms "pregnancy" and one of the following: "valvular disease," "endocarditis," "coronary heart disease," "cardiomyopathy," "hypertension," "anticoagulation." We also took consideration of the relevant international medical society guidelines and of the new database of the Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie in Berlin (Embryotox).
There is a rising incidence, not only of hypertension during pregnancy, but also of valvular heart disease during pregnancy. Severe valvular stenosis, particularly mitral stenosis, raises the risk of pulmonary edema and should be treated before pregnancy, by valvuloplasty or surgically. Women with high-grade valvular insufficiency and restricted left-ventricular function are at risk of heart failure. For women with mechanical heart valves, the type of anticoagulation during pregnancy must be discussed on an individual basis. Coumarin derivatives are associated with an elevated risk of hemorrhage as well as coumarin embryopathy; recent studies have shown that the latter risk is low and dose-dependent. Spontaneous dissection of the coronary arteries is best treated by catheter intervention with the implantation of a bare metal stent.
Women of child-bearing age who are at risk for, or already have, cardiovascular disease should receive early counseling and treatment, not just from their family physician, but from an interdisciplinary team composed of gynecologists, cardiologists, and, if necessary, cardiac surgeons.
心血管疾病在工业化世界的所有妊娠中占 0.2%至 4%。在德国，这种有时致命的并发症每年影响大约 30000 名孕妇。
我们在 NCBI 数据库中进行了简单的文献检索，检索了 2008 年至 2010 年期间发表的包含搜索词“妊娠”和以下一个或多个搜索词的出版物：“瓣膜病”、“心内膜炎”、“冠心病”、“心肌病”、“高血压”、“抗凝”。我们还考虑了相关的国际医学协会指南以及柏林胚胎毒理学咨询和监测中心（Embryotox）的新数据库。
不仅妊娠高血压的发病率上升，妊娠期间的瓣膜性心脏病的发病率也在上升。严重的瓣膜狭窄，特别是二尖瓣狭窄，增加了肺水肿的风险，应在怀孕前通过瓣膜成形术或手术进行治疗。患有重度瓣膜功能不全和左心室功能受限的女性有心力衰竭的风险。对于患有机械性心脏瓣膜的女性，必须根据个体情况讨论怀孕期间的抗凝类型。香豆素衍生物与出血风险以及香豆素胚胎病相关；最近的研究表明，后者的风险较低且与剂量有关。冠状动脉自发性夹层最好通过导管介入治疗，植入裸金属支架。
有心血管疾病风险或已经患有心血管疾病的育龄妇女应接受早期咨询和治疗，不仅要接受家庭医生的治疗，还要接受由妇科医生、心脏病专家和必要时心脏外科医生组成的跨学科团队的治疗。
